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Lamback E, Filho FDC, Ventura N, Chimelli L, Christ-Crain M, Gadelha MR. Extraventricular Neurocytoma of the Sellar Region Presenting With Syndrome of Inappropriate Antidiuresis. JCEM CASE REPORTS 2024; 2:luae099. [PMID: 39156001 PMCID: PMC11327119 DOI: 10.1210/jcemcr/luae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Indexed: 08/20/2024]
Abstract
Neurocytomas are neuronal tumors that are usually intraventricular. Rare cases can arise from extraventricular sites. To our knowledge, only 29 cases of extraventricular neurocytoma of the sellar region (EVNSR) have been reported in the literature. We describe a case of a 39-year-old woman who presented with a one-month history of refractory headache, nausea and vomiting. Magnetic resonance imaging (MRI) showed a 5.1 × 3.1 × 2.2 cm sellar and suprasellar mass, suggestive of a pituitary adenoma (PA). She had hyponatremia, obstructive hydrocephalus, and panhypopituitarism at presentation (hypogonadism, adrenal insufficiency). After glucocorticoid replacement therapy and ventriculoperitoneal shunt, the vomiting and headache resolved, but she remained with nausea and hyponatremia. She was submitted to surgery, and histopathological analysis revealed a neurocytoma with positive immunostaining for arginine vasopressin. Syndrome of inappropriate antidiuresis (SIAD) was diagnosed but did not resolve after surgery due to residual tumor, despite fluid restriction and saline replacement. SIAD later resolved with empagliflozin. In conclusion, EVNSR is extremely rare and can be misdiagnosed as PA on MRI. In the context of SIAD and extraventricular neurocytoma, a secreting arginine vasopressin tumor must be considered. SIAD can be challenging to treat, with excision of the EVNSR the treatment choice and, alternatively, empagliflozin associated with fluid restriction.
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Affiliation(s)
- Elisa Lamback
- Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Ferdinand Duenas Cabrera Filho
- Neuroradiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Nina Ventura
- Neuroradiology Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Leila Chimelli
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel 4001, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel 4001, Switzerland
| | - Mônica R Gadelha
- Neuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-617, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
- Neuroendocrine Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro 20231-092, Brazil
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Park YW, Vollmuth P, Foltyn-Dumitru M, Sahm F, Choi KS, Park JE, Ahn SS, Chang JH, Kim SH. The 2021 WHO Classification for Gliomas and Implications on Imaging Diagnosis: Part 3-Summary of Imaging Findings on Glioneuronal and Neuronal Tumors. J Magn Reson Imaging 2023; 58:1680-1702. [PMID: 37715567 DOI: 10.1002/jmri.29016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 09/17/2023] Open
Abstract
The fifth edition of the World Health Organization classification of central nervous system tumors published in 2021 reflects the current transitional state between traditional classification system based on histopathology and the state-of-the-art molecular diagnostics. This Part 3 Review focuses on the molecular diagnostics and imaging findings of glioneuronal and neuronal tumors. Histological and molecular features in glioneuronal and neuronal tumors often overlap with pediatric-type diffuse low-grade gliomas and circumscribed astrocytic gliomas (discussed in the Part 2 Review). Due to this overlap, in several tumor types of glioneuronal and neuronal tumors the diagnosis may be inconclusive with histopathology and genetic alterations, and imaging features may be helpful to distinguish difficult cases. Thus, it is crucial for radiologists to understand the underlying molecular diagnostics as well as imaging findings for application on clinical practice. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University College of Medicine, Heidelberg, Germany
| | - Martha Foltyn-Dumitru
- Department of Neuroradiology, Heidelberg University College of Medicine, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University College of Medicine, Heidelberg, Germany
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Ricciuti RA, Mancini F, Ricciuti V, Paracino R. Awake craniotomy in an adolescent patient with an extraventricular neurocytoma. BMJ Case Rep 2023; 16:e256102. [PMID: 37977834 PMCID: PMC10660200 DOI: 10.1136/bcr-2023-256102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Affiliation(s)
| | - Fabrizio Mancini
- Neurosurgery, Azienda Ospedaliera di Perugia, Perugia, Umbria, Italy
| | - Vittorio Ricciuti
- Neurosurgery, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Riccardo Paracino
- Neurosurgery, Azienda Ospedaliera di Perugia, Perugia, Umbria, Italy
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Machine learning–based multiparametric magnetic resonance imaging radiomics model for distinguishing central neurocytoma from glioma of lateral ventricle. Eur Radiol 2022; 33:4259-4269. [PMID: 36547672 DOI: 10.1007/s00330-022-09319-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/16/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To develop a machine learning-based radiomics model based on multiparametric magnetic resonance imaging (MRI) for preoperative discrimination between central neurocytomas (CNs) and gliomas of lateral ventricles. METHODS A total of 132 patients from two medical centers were enrolled in this retrospective study. Patients from the first medical center were divided into a training cohort (n = 74) and an internal validation cohort (n = 30). Patients from the second medical center were used as the external validation cohort (n = 28). Features were extracted from contrast-enhanced T1-weighted and T2-weighted images. A support vector machine was used for radiomics model investigation. Performance was evaluated using the sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). The model's performance was also compared with those of three radiologists. RESULTS The radiomics model achieved an AUC of 0.986 in the training cohort, 0.933 in the internal validation cohort, and 0.903 in the external validation cohort. In the three cohorts, the AUC values were 0.657, 0.786, and 0.708 for radiologist 1; 0.838, 0.799, and 0.790 for radiologist 2; and 0.827, 0.871, and 0.862 for radiologist 3. When assisted by the radiomics model, two radiologists improved their performance in the training cohort (p < 0.05) but not in the internal or external validation cohorts. CONCLUSIONS The machine learning radiomics model based on multiparametric MRI showed better performance for distinguishing CNs from lateral ventricular gliomas than did experienced radiologists, and it showed the potential to improve radiologist performance. KEY POINTS • The machine learning radiomics model shows excellent performance in distinguishing CNs from gliomas. • The radiomics model outweighs two experienced radiologists (area under the receiver operating characteristic curve, 0.90 vs 0.79 and 0.86, respectively). • The radiomics model has the potential to enhance radiologist performance.
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Byun J, Kim M, Song SW, Kim YH, Hong CK, Kim JH. Extraventricular Neurocytoma: Clinical Investigation of Heterogenous Prognosis. Brain Tumor Res Treat 2022; 10:22-28. [PMID: 35118844 PMCID: PMC8819464 DOI: 10.14791/btrt.2022.10.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Extraventricular neurocytoma (EVN) is an extremely rare neuronal neoplasm that arises outside the ventricle. The clinical implication of the heterogenous prognosis of this rare tumor has not yet been clarified. Herein, we analyzed our institutional series of EVN. METHODS A total of eight consecutive cases were enrolled and investigated. The prognosis of EVN was analyzed and compared to that of central neurocytoma (CN). RESULTS There were two male and six female patients, and the median age was 36.5 years. The median tumor size was 38 mm, and the most common location of the tumor was the frontal lobe (3, 37.5%), followed by the parietal and temporal lobes. In brain imaging, four (50%) tumors showed peritumoral edema and three (37.5%) tumors showed calcification. All patients underwent gross total resection, and two (25%) underwent adjuvant radiotherapy. The 5-year overall survival (OS) was 55.6%, and the 2-year progression-free survival (PFS) was 42.9%. The OS and PFS of EVN were poor compared to those of CN. Although EVN is a single disease entity, individual patients showed varying prognosis. One patient showed no recurrence during the 7-year follow-up period; however, another patient had a recurrence 4 months after surgery and died 2 years later. CONCLUSION EVN may be a heterogenous disease entity. Additional cases with long-term followup are needed to develop optimal management protocols.
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Affiliation(s)
- Joonho Byun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Moinay Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Woo Song
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ki Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhang L, Fu W, Zheng L, Song F, Chen Y, Jiang C, Xing Z, Hu C, Ye Y, Zhang S, Yan X, Wang X. A Clinicopathological and Molecular Analysis of Sellar/Suprasellar Neurocytoma Mimicking Pituitary Adenoma. Front Endocrinol (Lausanne) 2022; 13:861540. [PMID: 35663322 PMCID: PMC9157436 DOI: 10.3389/fendo.2022.861540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the clinicopathological characteristics, molecular genetic characteristics and prognosis of extraventricular neurocytoma located in the sellar/suprasellar region. METHODS Seven archived tumor samples derived from 4 patients with neurocytoma in the sellar/suprasellar region were collected from the First Affiliated Hospital of Fujian Medical University and the Affiliated Hospital of Qingdao University and retrospectively analyzed for clinical manifestations, imaging features, and histopathological features. Neuronal and pituitary biomarkers and molecular features were detected in these tumor tissues by immunohistochemistry and FISH or Sanger sequencing. The related literature was reviewed. RESULTS Three patients were female, while 1 was male, with an average age of 35.5 years (range: 27 to 45 years). The initial manifestations were mainly headache and blurred vision in both eyes. The first MRI examination showed marginally enhancing masses in the intrasellar or intra- to suprasellar region. The diagnosis of pituitary adenomas was based on imaging features. The levels of pituitary hormones were normal. Histologically, the tumor cells were arranged in a sheet-like, monotonous architecture and were uniform in size and shape with round to oval, exquisite and hyperchromatic nuclei, which densely packed close to one another and were separated only by a delicate neuropil background. There was no evident mitosis, necrosis or microvascular proliferation. The three cases of recurrent tumors were highly cellular and showed increased mitotic activity. Immunohistochemically, the tumor cells were positive for syn, CR, CgA, and vasopressin and were focally positive for NeuN, TTF-1, NF, CK8, vimentin, and S100 proteins. Other markers, including IDH1, BRAF VE1, Olig-2, and EMA, were negative. Pituitary transcription factors and anterior pituitary hormones were negative. Molecular genetic testing showed that the tumor cells lacked IDH gene mutations, LOH of 1p/19q, MYCN amplification, and EGFR alteration. With a median follow-up of 74.5 months (range 23 to 137 months), 3 patients relapsed at 11, 50, and 118 months after the initial surgery. CONCLUSION The morphological features and immunophenotypes of neurocytoma in the sellar/suprasellar region are similar to those of classic central neurocytoma. The prognosis is relatively good. Gross-subtotal resection and atypical subtype may be related to tumor recurrence.
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Affiliation(s)
- Lifeng Zhang
- Department of Endocrinology, Fujian Provincial Governmental Hospital, Fuzhou, China
| | - Weiwei Fu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Limei Zheng
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fangling Song
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yupeng Chen
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Changzhen Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhen Xing
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chengcong Hu
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuhong Ye
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Sheng Zhang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaorong Yan
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Xingfu Wang, ; Xiaorong Yan,
| | - Xingfu Wang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Xingfu Wang, ; Xiaorong Yan,
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Gaggero G, Valle L, Ferro J, Taietti D, Spina B. Extraventricular neurocytoma. Autops Case Rep 2021; 12:e2021348. [PMID: 35036366 PMCID: PMC8745375 DOI: 10.4322/acr.2021.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gabriele Gaggero
- Ospedale Policlinico San Martino, IRCCS, Anatomic Pathology Unit, Genoa, Italy
| | - Luca Valle
- Università di Genova, Scuola di Scienze Mediche e Farmaceutiche, Department of Integrated Surgical and Diagnostic Sciences, Division of Anatomic Pathology, Genoa, Italy
| | - Jacopo Ferro
- Università di Genova, Scuola di Scienze Mediche e Farmaceutiche, Department of Integrated Surgical and Diagnostic Sciences, Division of Anatomic Pathology, Genoa, Italy
| | - Davide Taietti
- Azienda Socio Sanitaria Territoriale, Ospedale Maggiore, Anatomic Pathology Unit, Crema, Italy
| | - Bruno Spina
- Ospedale Policlinico San Martino, IRCCS, Anatomic Pathology Unit, Genoa, Italy
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Gallego-Henao K, Ramos-Delgado JM, Moreno-Blanco A, Placido-Méndez A, Zarate-Mendez A. Extraventricular Neurocytoma in Parietal Lobe. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1727546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractExtraventricular neurocytoma (EVN) was classified as a World Health Organization (WHO) grade II tumor; however, EVN is not fully understood; it presents a variable histological feature that included oligodendroglioma-like, neuropil-like matrix, ganglion or gangloid cells, perivascular pseudorosettes, vessel hyalinization, calcifications, and myxoid degeneration. In some very rare cases, atypical histological features such as increased mitotic figures, focal necrosis, endothelial cell proliferation, and Ki-67 index of >2% made this tumor more aggressive and more susceptible to recur. We present the case of a young patient who presents with a 2-year history of seizure without other symptoms. Magnetic resonance imaging reveals a parietal lobe and well-circumscribed lesion treated by gross total resection and adjuvant radiotherapy. Clear guidelines to treat this kind of lesions are not well established and there is not a consensus of correct treatment in these tumors.
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Affiliation(s)
- Katherine Gallego-Henao
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, México
| | - José M. Ramos-Delgado
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, México
| | - Angelica Moreno-Blanco
- Department of Pathology, Centro Medico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, México
| | - Aureliano Placido-Méndez
- Department of Pathology, Centro Medico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, México
| | - Antonio Zarate-Mendez
- Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, México
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Gaggiotti C, Giammalva GR, Raimondi M, Florena AM, Gerardi RM, Graziano F, Tumbiolo S, Iacopino DG, Maugeri R. A rare diagnosis of an extraventricular neurocytoma. Surg Neurol Int 2021; 12:88. [PMID: 33767892 PMCID: PMC7982114 DOI: 10.25259/sni_951_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/09/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Extraventricular neurocytoma (EVN) is an extremely rare neoplasm of the central nervous system. As reported, it arises in a variety of locations, but mainly within the cerebral hemispheres. Despite its histological similarity with central neurocytoma (CN), EVN occurs outside the ventricular system and, in 2007, was recognized by the World Health Organization as a separate entity. Case Description: A 39-year-old man, with a ventriculoperitoneal shunt inserted for communicating hydrocephalus, was admitted at our Unit of Neurosurgery with a 1-month history of gait disturbance, postural instability, speech disorders, and occasional incontinence. Computed tomography scan and magnetic resonance imaging showed a mixed-density neoplasm in the left frontotemporal area, with anterior cerebral falx shift, and perilesional edema. The patient underwent surgical procedure; microsurgical excision of the lesion was performed through left pterional approach. Histopathological and immunohistochemical examination revealed monomorphic round cells of the neuronal lineage, with a percentage of Ki-67 positive nuclei <5% and no evidence of mitosis or necrotic areas. According to radiologic features, this pattern was compatible with the diagnosis of EVN. Patient had a favorable recovery and he is still in follow-up. Conclusion: Because of their rarity, clinical, radiologic, and histopathological characteristics of EVNs are not yet well defined, as well as the optimal therapeutic management. Whereas EVNs are rarely described in literature, we aimed to share and discuss our experience along with a review of the published literature.
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Affiliation(s)
- Claudia Gaggiotti
- Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Italy
| | - Giuseppe Roberto Giammalva
- Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Italy
| | - Marco Raimondi
- Department of Scienze per la Promozione della Salute e Materno Infantile, Pathology Unit, University of Palermo, Italy
| | - Ada Maria Florena
- Department of Scienze per la Promozione della Salute e Materno Infantile, Pathology Unit, University of Palermo, Italy
| | - Rosa Maria Gerardi
- Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Italy
| | - Francesca Graziano
- Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Italy
| | - Silvana Tumbiolo
- Department of Neurosciences and Emergency, Division of Neurosurgery, Villa Sofia Hospital, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Italy
| | - Rosario Maugeri
- Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Italy
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Abstract
Neuronal and mixed glioneuronal tumors represent a group of neoplasms with varying degrees of neural and glial elements. Their age of presentation varies, but they are most commonly seen in children and young adults. With the exception of anaplastic ganglioglioma and other atypical variants, most lesions are low grade; however, they can have significant morbidity because of seizures, mass effect, or difficult to treat hydrocephalus. Although many tumors show overlapping clinical and imaging features, some have relatively distinctive imaging characteristics that may aid in narrowing the differential diagnosis. In this review, we discuss relevant clinical and pathologic characteristics of these tumors and provide an overview of conventional and advanced imaging features that provide clues as to the diagnosis.
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Romano N, Federici M, Castaldi A. Imaging of extraventricular neurocytoma: a systematic literature review. Radiol Med 2020; 125:961-970. [PMID: 32335813 DOI: 10.1007/s11547-020-01198-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/13/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Extraventricular neurocytoma (EVN) was firstly described in 1997. The current literature regarding imaging of EVN is limited to sporadic case reports and case series. EVN is still poorly considered in the differential diagnosis by neuroradiologists, thus diagnosis remains challenging. In this systematic review, we summarize and discuss computed tomography (CT) and magnetic resonance imaging (MRI) features of EVN cases described in the literature, in order to provide useful informations to neuroradiologists. To the best of our knowledge, this is the most extensive review about imaging of EVN. MATERIALS AND METHODS A systematic review of the literature about imaging of EVN cases was done. Only case reports or case series in which imaging (CT and/or MRI) features were deeply described were included in the revision. Eligibility of studies was assessed independently by two authors and any disagreements resolved by discussion. RESULTS Our search strategy revealed 224 articles. After implementation of inclusion and exclusion criteria, 35 studies were considered, and a total of 79 cases of EVN were analyzed. CONCLUSION EVN has not specific characteristics, with a large and variable imaging spectrum. Usually it appears as a large tumor, with diameters superior to 40 mm, frequently involving the frontal lobe. CT density and MRI signal intensity typically mirror the presence of cystic, solid, or calcified elements; contrast enhancement is visible in 87% of cases. Today, diagnosis of EVN with only imaging techniques is not univocal; neuroradiologists can only suspect this type of lesion, while the definitive diagnosis remains histological.
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Affiliation(s)
- Nicola Romano
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16028, Genoa, Italy.
| | - Margherita Federici
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16028, Genoa, Italy
| | - Antonio Castaldi
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16028, Genoa, Italy
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12
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Atypical Extraventricular Neurocytoma: Imaging Findings of Disregarded Diagnosis. World Neurosurg 2019; 129:186-187. [DOI: 10.1016/j.wneu.2019.05.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
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13
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Nery B, Bernardes Filho F, Costa RAF, Pereira LCT, Quaggio E, Queiroz RM, Abud LG, da Cunha Tirapelli DP. Neurocytoma mimicking macroadenoma. Surg Neurol Int 2019; 10:8. [PMID: 30775062 PMCID: PMC6357540 DOI: 10.4103/sni.sni_387_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/28/2018] [Indexed: 11/04/2022] Open
Abstract
Background Intraventricular and extraventricular central neurocytomas (CN) are equally frequent among 20-40-year-old men and women. However, sellar and suprasellar extraventricular CN are extremely rare, with only 12 reported cases. Case Description The authors report the case of a Brazilian 27-year-old man who presented with progressive vision loss during the last 4 years and serious bilateral keratoconus. We also review the epidemiological, clinical, radiological, pathological, and treatment features of the 12 reported cases. The patient developed left amaurosis and right temporal hemianopsia after undergoing bilateral corneal transplantation, which was detected during campimetry testing, and subsequently underwent magnetic resonance imaging, which revealed a huge hypophyseal tumor. Endocrinological evaluation revealed complete loss of pituitary function. The patient was referred to our department and underwent a two-step surgery (using transsphenoidal approach and cranio-orbital zygomatic approach) based on the diagnosis of an extraventricular central nervous system neurocytoma. Tumor removal was successful, and the patient was discharged at 3 weeks after admission to our department. Conclusion Although extraventricular neurocytomas of the brain are rare, careful preoperative consideration of its anatomy, pathophysiological features, and radiological features can enhance the treatment outcomes.
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Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Fred Bernardes Filho
- Department of Internal Medicine, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Eduardo Quaggio
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Rodolfo Mendes Queiroz
- Department of Documenta Advanced Radiological Center, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Giansante Abud
- Department of Documenta Advanced Radiological Center, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
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Zhang A, Brown DF, Colpan EM. Mesial temporal extraventricular neurocytoma (mtEVN): A case report and literature review. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 11:26-30. [PMID: 30603610 PMCID: PMC6310741 DOI: 10.1016/j.ebcr.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Abstract
Aim We describe a case of mesial temporal extraventricular neurocytoma (mtEVN) in a 23-year-old male presenting with drug-resistant seizures and review the literature on this rare tumor. Methods A PubMed search was queried using the MeSH term "neurocytoma" and key search terms "extraventricular", "temporal", and "epilepsy". Titles and abstracts were screened for temporal neurocytomas. References were reviewed to identify further studies. Results Twenty case reports were selected comparing the presentation, radiological, histopathological, and surgical outcomes of neocortex temporal EVNs (ntEVN) and mtEVNs. Conclusion Gross total resection of mtEVNs under intraoperative electrocorticography monitoring typically affords an excellent prognosis and successful seizure control.
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Key Words
- ADC, apparent diffusion coefficient
- Case review
- ECoG, intraoperative electrocorticography
- EEG, electroencephalogram
- EVN, extraventricular neurocytoma
- Epilepsy
- Extraventricular neurocytoma
- FIAS, focal impaired awareness seizure
- Focal impaired awareness seizure
- GFAP, glial fibrillary acidic protein
- GTR, gross total resection
- MAP-2, microtubule associated protein 2
- MRI, magnetic resonance imaging
- NeuN, neuronal nuclei
- PLEDS, periodic lateralized epileptiform discharges
- STR, subtotal resection
- Surgical oncology
- Temporal lobe tumors
- mtEVN, mesial temporal extraventricular neurocytoma
- ntEVN, neocortical temporal extraventricular neurocytoma
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Affiliation(s)
- Angie Zhang
- University of South Florida, Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC 41, Tampa, FL, 33612, United States of America.,Division of Neurological Surgery, Department of Surgery, Lehigh Valley Health Network, 1250 S Cedar Crest Blvd, Suite 400, Allentown, PA 18103, United States of America
| | - Daniel F Brown
- Department of Pathology & Laboratory Medicine, Lehigh Valley Health Network, P.O. Box 689, Cedar Crest & I-78, Allentown, PA 18105, United States of America.,Health Network Laboratories, 1200 S. Cedar Crest Blvd., Allentown, PA 18078, United States of America
| | - Efkan M Colpan
- Division of Neurological Surgery, Department of Surgery, Lehigh Valley Health Network, 1250 S Cedar Crest Blvd, Suite 400, Allentown, PA 18103, United States of America
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Jiang M, Long L, Zeng J, Meng W, Zee C. Imaging characteristics of cerebral extraventricular neurocytoma with pathological correlation. J Neurooncol 2018; 140:289-296. [PMID: 30062611 DOI: 10.1007/s11060-018-2952-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/13/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Extraventricular neurocytoma (EVN) is an exceedingly rare tumor. In this study, we sought to characterize the imaging and pathological features of this uncommon tumor. METHODS Retrospective review of 18 patients (9 male; 9 female) with pathologically confirmed EVN treated at a single center between 2005 and 2017. RESULTS All patients had a solitary lesion. Sixteen lesions were found in hemispheres. The greatest tumor diameter ranged from 2.6 to 8 cm. The lesions were generally solid with cystic components; the solid portion appeared isodense or hyperdense on CT, isointense to hypointense on T1WI, and slightly hyperintense on T2WI. Heterogeneous hyperintensity interspersed with isointense or hypointense areas suggestive of hemorrhage, calcification or vascular flow voids were seen on T2WI. Heterogeneous enhancement was noted in 17 lesions; no enhancement was observed in one lesion. Cystic components were observed in 13 lesions; 9 of these showed characteristic perilesional cysts (9/13). Mild to moderate peritumoral edema (15/18), calcification (4/16), intratumoral hemorrhage (11/18) and vascular flow voids (10/16) were observed in some lesions. Pathologically, tumor cells showed round nucleus and fine neuropil matrix. Foci of calcification in the solid portion of the tumor were seen in five cases. Microcystic changes were observed in almost all cases. Some lesions exhibited positive staining for synaptophysin (Syn) (15/16) and neuronal nuclei (NeuN) (7/8). MIB-1 was determined for 10 patients; seven of these had an MIB-1 ≥ 3. These six patients experienced recurrence; four of them relapsed twice. CONCLUSIONS EVNs occur as single intracranial solid mass with cystic components (especially peripherally located cysts); solid portion exhibits slight hyperintensity or heterogeneous signal intensity. Mild to moderate peritumoral edema, calcification, intratumoral hemorrhage and vascular flow voids were characteristic features of extraventricular neurocytoma. Positive staining for synaptophysin and neuronal nuclei confirmed the diagnosis. A combination of atypical pathologic features and atypical radiologic features should be considered for prognostic assessment.
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Affiliation(s)
- Muliang Jiang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Jingjing Zeng
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Wei Meng
- Department of Radiology, Shunde Hospital of Southern Medical University, Shunde, 528308, Guangdong, China
| | - ChiShing Zee
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
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16
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Chen F, Jin R, Wu X, Dong Z, Chen D. Extraventricular Neurocytoma in the Left Frontal Lobe: A Case Report and Literature Review. World Neurosurg 2018; 112:178-181. [PMID: 29378347 DOI: 10.1016/j.wneu.2018.01.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurocytoma is a rare brain neoplasm of neuroepithelial origin that occurs predominantly in the ventricular system adjacent to the interventricular foramen and septum pellucidum. However, extraventricular neurocytoma is an extremely rare entity, with poor clinical, radiologic, and histopathological characterization. Here we report a case of an extraventricular parafalcine neurocytoma in the left frontal lobe. We also examine previously reported cases of extraventricular neurocytoma in an attempt to provide an up-to-date summary of the condition. METHODS A literature search was performed using PubMed with specific key terms, inclusion criteria, and exclusion criteria. Selected case studies and case series were then compared, and statistical analyses were performed where appropriate. We report a 59-year-old woman presenting with weakness in her right leg and urinary incontinence. Physical examination revealed muscle strength of grade 3/5 in the right lower extremity. Brain magnetic resonance imaging showed a parafalcine mass in the left frontal lobe, with perilesional edema; the cerebral falx and lateral ventricle were shifted due to the compression. Gross total resection was performed. RESULTS Histopathological examination revealed a neurocytoma. Immunohistochemical staining showed diffuse positivity for synaptophysin. MIB-1 staining for Ki-67 antibody showed a labeling index of 20%. No adjuvant radiation or chemotherapy was administered. Brain computed tomography performed at a 3-month follow-up showed no signs of recurrence. CONCLUSION Extraventricular neurocytoma occurring in the brain parenchyma is a very rare central nervous system tumor. Its clinical and radiologic manifestations are nonspecific. The diagnosis depends on histopathological and immunohistochemical examination. Surgical resection should be the first-choice treatment.
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Affiliation(s)
- Fan Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Rihua Jin
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xinmin Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Zengping Dong
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Dawei Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
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Central Versus Extraventricular Neurocytoma in Children: A Clinicopathologic Comparison and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:479-85. [PMID: 27438020 DOI: 10.1097/mph.0000000000000627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central neurocytomas (CN) are rare pediatric CNS tumors most often with a benign clinical course. Occasionally, these tumors occur outside the ventricles and are called extraventricular neurocytomas (EVN). We present a retrospective institutional analysis of children with neurocytoma with prolonged follow-up. PROCEDURE Twelve patients were diagnosed with neurocytoma at our institution between 1993 and 2004. RESULTS Six patients were male and the median age at diagnosis was 12 years (1.5 to 16 y). Seven patients had CN and 5 had EVN. Presenting symptoms included headaches (67%), vomiting (50%), nausea (33%), seizures (33%), and mental status changes (25%). Obstructive hydrocephalus was present at diagnosis in 42% of the cases. Younger age and seizures were more common in patients with EVN. Gross total resection (GTR) was achieved in 42% (5/12) of the patients. Patients with GTR received no adjuvant therapy upfront; 1 patient subsequently had recurrence with leptomeningeal disease. Patients with subtotal resection received additional treatment: 1 underwent reoperation (GTR), 2 patients received focal radiation, 2 patients received adjuvant chemotherapy, and 2 patients received craniospinal irradiation followed by chemotherapy. The 20-year overall survival for this cohort was 83% with event free survival of 56%. Overall survival for CNs was 100%, versus 40% for EVN. Event free survival for CNs was 57% and 53% for the EVNs. An MIB-1 fraction >2% was associated with worse prognosis. CONCLUSIONS Neurocytomas are rare brain tumors in children usually cured with GTR. Adjuvant focal radiation therapy and/or chemotherapy may improve disease control in cases with subtotal resection, but case-by-case analysis should be done. EVNs might be associated with worse outcome due to a higher proliferative index.
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Ji YC, Hu JX, Li Y, Yan PX, Zuo HC. Extraventricular neurocytoma in the left temporal lobe: A case report and review of the literature. Oncol Lett 2016; 11:3579-3582. [PMID: 27313678 PMCID: PMC4888045 DOI: 10.3892/ol.2016.4487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/19/2016] [Indexed: 02/04/2023] Open
Abstract
Central neurocytoma (CNC) often develops in the ventricular system adjacent to the interventricular foramen and septum pellucidum. According to the World Health Organization, CNCs are classified as grade II tumors, and in recent years it has been reported that CNCs have occasionally occurred in rare areas of the central nervous system. The current study describes a rare case of CNC located in the left temporal lobe of a 49-year-old man, who had been experiencing headaches for 3 weeks. Computed tomography identified a round, well-demarcated, 3.3-cm tumor in the left temporal lobe. The patient underwent surgery and the tumor was totally resected. Histological analysis demonstrated that the resected tumor tissue contained clusters of small cells with regular nuclear morphology, and round nuclei with fine chromatin. Immunohistochemically, neuronal differentiation markers, including synaptophysin and neuronal nuclear antigen, were expressed in the tumor cells. Histopathological examination of the resected tissue confirmed a diagnosis of extraventricular neurocytoma. Magnetic resonance imaging was performed at 3 months post-surgery and demonstrated no evidence of tumor recurrence.
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Affiliation(s)
- Yu-Chen Ji
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China; Medical Center, Tsinghua University, Beijing 100084, P.R. China
| | - Jing-Xia Hu
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China; Medical Center, Tsinghua University, Beijing 100084, P.R. China
| | - Yan Li
- Medical Center, Tsinghua University, Beijing 100084, P.R. China
| | - Peng-Xiang Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Huan-Cong Zuo
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China; Medical Center, Tsinghua University, Beijing 100084, P.R. China
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The typical and atypical MR imaging findings of central neurocytomas: Report on eighteen cases and review of the literature. Clin Neurol Neurosurg 2016; 146:18-23. [PMID: 27132079 DOI: 10.1016/j.clineuro.2016.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/29/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
There were few studies have documented the MRI features of typical and atypical CNCs for diagnosis and therapeutic modalities. Here, 18 histopathologically confirmed cases of intracranial CNCs (8 men and 10 women with a mean age of 28.3 years, range 10-64 years) were retrospectively analyzed. The histopathological and immunohistochemical features were also assessed. On MR imaging, the 14 typical cases of CNCs showed relatively round, lobulated tumor masses in the body of the right lateral ventricle (5 cases), left lateral ventricle (4 cases), third ventricles (2 cases), and midline (3 cases). These typical CNCs masses contained clusters of cysts of varying sizes and "soap bubble" appearance on T2WI; they showed mild to moderate heterogeneously enhancement on T1WI. The 4 atypical cases of CNCs showed as strongly contrast enhancement of the tumors with the attachment or infiltrate of the wall of the ventricle than the typical benign cases. These atypical CNCs were in the right lateral ventricle (2 cases), left lateral ventricle (1 case), and third ventricle (1 case). Microscopically, the typical CNCs were well-differentiated tumors with benign histological features. The typical and atypical CNCs were composed of uniform, small to medium-sized cells with rounded nuclei and scant cytoplasm. Immunohistochemically, the typical CNCs were strong in Syn immunopositive (14/14) and neuron-specific enolase (12/14). The atypical CNC tumor cells showed malignant behavior and more positive expression of Ki67 than the benign cases. Surgery is the first choice of treatment, and radiotherapy may be beneficial to postoperative patients.
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Yang I, Ung N, Chung LK, Nagasawa DT, Thill K, Park J, Tenn S. Clinical manifestations of central neurocytoma. Neurosurg Clin N Am 2015; 26:5-10. [PMID: 25432178 DOI: 10.1016/j.nec.2014.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central neurocytomas (CNs) are rare central nervous system tumors that occur in the lateral ventricles. They are prevalent in young adults and are typically benign with excellent prognosis following surgical resection. Because of the rarity of the disease and its similar features with more common tumors, misdiagnosis becomes an issue. Optimal treatment is achieved only when the correct tumor types are distinguished. Typical clinical manifestations include symptoms of increased intracranial pressure, although no clinical feature is pathognomonic to CN. Radiologic imaging, histology, magnetic resonance spectroscopy, and immunohistochemistry must be used to elucidate tumor characteristics and properly diagnose CN.
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Affiliation(s)
- Isaac Yang
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA.
| | - Nolan Ung
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lawrance K Chung
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel T Nagasawa
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA
| | - Kimberly Thill
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA
| | - Junmook Park
- Department of Neurological Surgery, University of California Los Angeles, 300 Stein Plaza, Ste. 562, 5th Floor, Wasserman Bldg., Los Angeles, CA 90095-6901, USA; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen Tenn
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
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22
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Extraventricular neurocytoma, a comprehensive review. Acta Neurochir (Wien) 2014; 156:349-54. [PMID: 24357019 DOI: 10.1007/s00701-013-1971-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/04/2013] [Indexed: 02/02/2023]
Abstract
AIMS AND OBJECTIVE Extra ventricular neurocytoms (EVN) are a rare parenchymal brain tumour distinct from central neurocytomas. This review attempts to analyze a series of seven cases of EVN from a single institute against the background of available literature. METHOD Retrospective analysis of the clinical manifestation, pathological features, imaging findings, microsurgical treatment effectiveness and progression free survival of seven cases of EVN operated between 2000-2012. RESULTS The study group included five females and two males in the age group 7-65 years (mean 30.71 yrs). The distribution of the lesion was as follows Lobar 4, Cerebellum 1, Pineal 1, spinal 1. The duration of clinical symptoms ranged from three months to seven years and the presentation was site and size specific. Cystic Changes (71 %), perilesional oedema (57 %) and heterogeneous contrast enhancement (85.7 %), and calcification (42 %) were a few distinct imaging characteristics. Increased perfusion correlated with atypical histology in two patients. Surgical resection remains the main management strategy for longer outcome and patients with STR + RT and GTR had comparable follow-up. Extremes of age and atypical histological features were adverse prognostic factors. CONCLUSION EVN are rare tumors with either glial or neuronal differentiation or a potential for atypical changes. Both, GTR and STR combined with RT, offer reasonably good outcome with overall comparable survival. The available literature of EVN is limited, larger series with long term follow-ups are needed to dictate the management protocol. The role of adjuvant therapy is still debatable and needs further validation.
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Pharmacodynamic analysis of magnetic resonance imaging-monitored focused ultrasound-induced blood-brain barrier opening for drug delivery to brain tumors. BIOMED RESEARCH INTERNATIONAL 2013; 2013:627496. [PMID: 23607093 PMCID: PMC3626247 DOI: 10.1155/2013/627496] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/25/2013] [Indexed: 12/22/2022]
Abstract
Microbubble-enhanced focused ultrasound (FUS) can enhance the delivery of therapeutic agents into the brain for brain tumor treatment. The purpose of this study was to investigate the influence of brain tumor conditions on the distribution and dynamics of small molecule leakage into targeted regions of the brain after FUS-BBB opening. A total of 34 animals were used, and the process was monitored by 7T-MRI. Evans blue (EB) dye as well as Gd-DTPA served as small molecule substitutes for evaluation of drug behavior. EB was quantified spectrophotometrically. Spin-spin (R1) relaxometry and area under curve (AUC) were measured by MRI to quantify Gd-DTPA. We found that FUS-BBB opening provided a more significant increase in permeability with small tumors. In contrast, accumulation was much higher in large tumors, independent of FUS. The AUC values of Gd-DTPA were well correlated with EB delivery, suggesting that Gd-DTPA was a good indicator of total small-molecule accumulation in the target region. The peripheral regions of large tumors exhibited similar dynamics of small-molecule leakage after FUS-BBB opening as small tumors, suggesting that FUS-BBB opening may have the most significant permeability-enhancing effect on tumor peripheral. This study provides useful information toward designing an optimized FUS-BBB opening strategy to deliver small-molecule therapeutic agents into brain tumors.
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